Individual
DR. JACOB STEPHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35.083380
OH
207RI0011X
Interventional Cardiology Physician
Primary
036133593
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE GROUP PTAN
IL
01
—
F40332641
MEDICARE INDIVID PTAN
IL
Enumeration date
09/26/2006
Last updated
08/15/2024
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